An Interview with Janel Burchfield, Psy.D., HSPP
Specific Learning Disorders (SLD) with impairment in reading and/or writing (also known as dyslexia) is one of the most common neurodevelopmental disorders included in the American Psychiatric Association’s Diagnostic and Statistical Manual – 5th Edition (2013). The prevalence rate ranges from 15% to 20% and SLD’s are found in all races and cultures. Dyslexia, as well as the other neurodevelopmental disorders, is a spectrum disorder. This means that the condition causes varying degrees of impairment from mild to severe. The International Dyslexia Association defines dyslexia as:
a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.
The incidence of dyslexia in males is greater than that found in females. Males with dyslexia are likely to have more significant impairment. However, females can and do have dyslexia and research is indicating that females with dyslexia are likely to have higher rates of anxiety and depression, especially as they enter college.
At CRG we specialize in the comprehensive evaluation of the neurodevelopmental and social/emotional components of a child or adolescent’s difficulties. Dr. Janel Burchfield is a psychologist at CRG with a specific focus on school-age children. Dr. Julie Steck interviewed Dr. Burchfield about her experience in working with girls with dyslexia.
JS: What is the most common learning disorder or neurodevelopmental disorder you see in children?
JB: Dyslexia and ADHD are the most common neurodevelopmental disorders we find in children. Individuals with ADHD do not necessarily have dyslexia but most of the children we see with dyslexia have ADHD.
JS: Do you find that girls can have dyslexia and ADHD?
JB: Yes, we very often find that females have ADHD and dyslexia. And we find that they exhibit a higher rate of anxiety and/or depression than do males. We often refer to it as the triad of symptoms in girls with dyslexia.
JS: What are the concerns that parents express when you are evaluating a child with a suspected learning disorder in reading comprehension, spelling and writing?
JB: Parents almost always report that their child likes to be read to but “hates to read” alone. Girls are usually well behaved at school but can have meltdowns when doing homework.
JS: How old does a child need to be to diagnose/identify dyslexia?
JB: Children, both male and female, can be diagnosed or at least identified at risk for a learning disorder in reading (dyslexia) in kindergarten or 1st grade. Indicators of risk include early language difficulties, difficulty with rhyming, difficulty with learning sequences of information such as days of the week and months of the year, and delayed ability to learn sound-symbol relationships in reading.
Note: Watch Yale dyslexia expert, Dr. Sally Shaywitz, testify before Congress and discuss early signs of dyslexia in this video.
JS: Why are children with dyslexia not identified through public school systems until later in elementary school?
JB: First, we probably need to discuss the difference between a clinical diagnosis of Specific Learning Disorders with impairment in reading and/or written expression as defined by DSM-5 and eligibility as a student with a Specific Learning Disability (SLD) under Indiana Article 7, the law which provides special education services in Indiana. The definition of a Specific Learning Disability in reading under Indiana Article 7 includes dyslexia. However, a clinical diagnosis of dyslexia does not necessarily mean that a student will qualify for special education services or supports. In fact, it is our experience that this may be the category in which it is most difficult to qualify for special education services.
Second, public schools do not generally evaluate or test for learning disorders until the student has demonstrated failure to respond to interventions. Over the past ten years, schools have moved to providing Response to Intervention (RTI) programs when students are experiencing academic difficulties. When a child receives intervention in the area of reading, they may demonstrate improvement in the skill being taught at the time. Later, however, they may lose those gains when the intervention stops or they fail to generalize the skill(s) in their daily work.
JS: What is the recommended course of intervention for girls with dyslexia?
JB: Intervention starts with diagnosis – diagnosis of dyslexia and other co-existing conditions. Following diagnosis, it is important that the parents become educated regarding the conditions that are impacting their daughter. If ADHD is present, it is important to consider medication for the core symptoms of ADHD. Without medication, the impact of school-based interventions or outside tutoring for dyslexia will be of minimal benefit. Parents are encouraged to share information about the diagnosis and recommendations with school personnel to coordinate interventions and develop a collaborative approach.
In addition, individual tutoring outside of school using a multi-sensory approach to phonetics is often appropriate to remediate the underlying deficits. As a child gets older, it is also important to accommodate the child’s reading and writing deficits through classroom accommodations and use of technology. An example of an accommodation is the use of books in audio-digital format. One example of this is Learning Ally, a subscription program that provides audio books to those with learning differences and dyslexia. Finally, it is important to keep an eye on the social and emotional aspects of the young female and to monitor for anxiety and depression.
JS: What is the prognosis for improvement in young females with dyslexia?
JB: Excellent! But only if the family knows what issues are causing the difficulties and have a game plan to address the dyslexia and co-existing conditions. The part of the brain in which dyslexia resides is malleable and appropriate interventions have been shown to be effective. And this is likely even more true in females who tend to have less severe symptoms of dyslexia and are more driven by anxiety to improve their performance.
Hawke, J.L. (2009). Gender ratios for reading difficulties. Dyslexia, 15(3), 239-242.
Nelson, J.M. & Gregg, N. (2012). Depression and anxiety among transitioning adolescent and college students with ADHD, dyslexia, or comorbid ADHD/dyslexia. Journal of Attention Disorders, 16(3), 244-254.
Shaywitz, S. (2005). Overcoming Dyslexia: A New and Complete Science-Based Program for Reading Problems at Any Level. New York: Random House, 2005.
Yale Center for Dyslexia & Creativity: http://dyslexia.yale.edu/EDU_whatisdyslexia.html